Wandering spleen is displacement of the spleen from its normal left upper quadrant position to an ectopic location. The spleen moves freely on its vascular pedicle due to congenital absence or laxity of supporting ligaments (gastrosplenic, splenocolic, splenorenal). Prevalence is <0.2%, making it a rare condition. More common in women. May be asymptomatic, but the most serious complication is torsion of the vascular pedicle — torsion can lead to splenic ischemia and infarction. Absence of spleen in normal position and 'whirl sign' (vascular pedicle twisting sign) on CT are pathognomonic findings.
Age Range
15-45
Peak Age
30
Gender
Female predominant
Prevalence
Rare
Wandering spleen develops from congenital absence or acquired laxity of peritoneal ligaments (gastrosplenic, splenorenal, splenocolic, phrenolienal) that hold the spleen in its normal anatomic position (left upper quadrant, below left hemidiaphragm). Without these ligaments, the spleen remains connected only by the vascular pedicle (splenic artery and vein) and can move freely within the abdomen/pelvis. In multiparity, abdominal wall laxity and hormonal changes increase ligament laxity. The spleen can migrate to the pelvic cavity, midline, right upper quadrant, and even the inguinal canal. Torsion of the vascular pedicle is the most serious complication — when the pedicle twists, venous return is first obstructed (congestion), then arterial flow ceases (ischemia and infarction). In torsion, 'whirl sign' develops: spiral twisting of the vascular pedicle is seen on CT — this finding is direct imaging of the torsion mechanism. Congested spleen shows increased size (splenomegaly) and decreased parenchymal enhancement (ischemia).
Spiral twisting of the splenic vascular pedicle (artery + vein) on CT arterial phase. Contrast-filled vessels form a helix around each other, directly demonstrating the torsion mechanism. This finding is pathognomonic for splenic torsion and requires emergent surgical intervention. Same principle as whirl sign in ovarian torsion and bowel volvulus.
Spleen is absent in the left upper quadrant splenic fossa on portal venous phase — only fat and bowel are seen in normal location. Spleen is found in ectopic location (pelvis, right lower quadrant, midline, left lower quadrant). Normal splenic morphology and size may be preserved or altered due to torsion.
Report Sentence
Spleen is not identified in the left upper quadrant splenic fossa; splenic tissue with normal splenic parenchymal enhancement pattern is found in [ectopic location], consistent with wandering spleen.
Spiral twisting of the vascular pedicle (splenic artery and vein) on arterial phase CT — 'whirl sign'. Vessels form a helix around each other. May show one or more complete rotations depending on degree of torsion. Mesenteric fat stranding may be seen around the pedicle.
Report Sentence
Spiral twisting of the splenic vascular pedicle (whirl sign) is seen, consistent with splenic torsion — urgent surgical evaluation recommended.
Decreased or heterogeneous splenic parenchymal enhancement in portal venous phase in presence of torsion. Loss of normal homogeneous enhancement due to venous congestion and/or arterial ischemia. In advanced stage, completely non-enhancing (avascular) spleen — indicator of complete infarction. Splenomegaly (congestion) and perisplenic fluid may accompany.
Report Sentence
Decreased/heterogeneous enhancement in the parenchyma of the ectopically located spleen, consistent with ischemia due to vascular pedicle torsion.
Spleen not visualized in normal left upper quadrant location on US. Solid organ structure showing normal splenic echopattern detected in pelvis or lower abdomen. Shows normal splenic echotexture (homogeneous, intermediate echogenicity) on B-mode. If torsion present, increased spleen size and heterogeneous echopattern may be seen.
Report Sentence
Spleen is not visualized in the left upper quadrant; solid structure showing normal splenic echopattern is found in [ectopic location], consistent with wandering spleen.
Reduced or absent splenic hilar flow on Doppler US in presence of torsion. Under normal conditions, splenic artery and vein show distinct flow at hilum. In torsion, arterial and venous flow decreases or disappears due to pedicle compression. In partial torsion, only venous flow may be reduced (low-pressure system affected first).
Report Sentence
Reduced/absent splenic hilar flow on Doppler examination of the ectopically located spleen, consistent with vascular pedicle torsion.
Torsioned wandering spleen shows heterogeneous signal on T2 MRI. Increased T2 signal in congested areas (edema), variable signal in infarct areas. While normal spleen shows homogeneous intermediate-high T2 signal, torsioned spleen shows heterogeneous pattern. Perisplenic fluid is T2 hyperintense.
Report Sentence
Heterogeneous T2 signal changes in the ectopically located spleen, consistent with congestion and ischemic changes.
Criteria
Congenital absence of peritoneal ligaments. Detected in childhood or young adulthood. Generally presents asymptomatic or with intermittent abdominal pain. Equal distribution in both sexes.
Distinct Features
Congenital, child/young adult, both sexes, ligament absence
Criteria
Ligament laxity develops due to multiparity, hormonal changes, or connective tissue diseases. More common in reproductive-age women. Decreased abdominal wall tone contributes.
Distinct Features
Acquired, multiparous woman, ligament laxity, hormonal factors
Criteria
Acute abdominal pain due to vascular pedicle torsion. Emergent surgical indication. Whirl sign + decreased splenic enhancement. Splenomegaly, perisplenic fluid. Splenic infarction and necrosis develop if untreated.
Distinct Features
Acute abdominal pain, whirl sign, decreased enhancement, emergent surgery, infarction risk
Distinguishing Feature
Splenic infarct usually develops with spleen in normal position and appears as wedge-shaped non-enhancing area. In wandering spleen torsion, spleen is ectopically located with global enhancement loss. Whirl sign is specific to wandering spleen torsion — no whirl sign in embolic infarcts.
Distinguishing Feature
Enlarged spleen in lymphoma remains in normal location and shows internal lesions/low-enhancement areas. In wandering spleen, spleen is in ectopic location and splenic fossa is empty. No whirl sign in lymphoma.
Distinguishing Feature
Metastasis forms focal lesions in splenic parenchyma with spleen in normal location. Wandering spleen shows diffuse enhancement changes and ectopic position. Known primary malignancy expected in metastasis history.
Distinguishing Feature
Ovarian torsion shows whirl sign in pelvic adnexal structure — wandering spleen pelvic torsion may show similar whirl sign. Differentiation aided by spleen's characteristic enhancement pattern (homogeneous intense enhancement) and size. Splenic echotexture distinguished from ovarian tissue on US.
Urgency
emergentManagement
surgicalBiopsy
Not NeededFollow-up
specialist-referralWandering spleen management is determined by presence of torsion. Acute torsion is an emergency — splenopexy (fixation of spleen to anatomic position) or splenectomy. If torsion duration is <6-8 hours and spleen is viable, splenopexy is preferred — splenic preservation is especially important in children (OPSI risk). If advanced ischemia/infarction present, splenectomy is mandatory. When asymptomatic wandering spleen is detected, elective splenopexy is recommended because torsion risk is ongoing. Laparoscopic splenopexy is a minimally invasive approach. Pneumococcal, meningococcal, and H. influenzae vaccines are mandatory in post-splenectomy patients.
Wandering spleen is clinically significant due to torsion risk. Torsion requires emergency surgery (detorsion + splenopexy or splenectomy). Prophylactic splenopexy (spleen fixation) is recommended in asymptomatic cases. Splenectomy is unavoidable if splenic infarct develops. Diagnosis is usually made by CT.